Publications


Emergency Contraceptive Pills: Selected, Annotated Bibliography* Print

Also available in [PDF] format.

The following resources have been carefully selected to lead health care providers, educators, and other youth serving professionals to high quality, reliable information on emergency contraceptive pills. This document includes online links to: medical organizations’ policy statements; Web sites and literature reviews; and consumer health information.

Medical Organizations’ Policy Statements on Emergency Contraceptive Pills

Position statements of prominent medical organizations regarding emergency contraceptive pills, their efficacy, and availability can be viewed at the Web links given below. Where noted, the statement is only available to members.

American Academy of Pediatrics, Committee on Adolescence. Emergency contraception: policy statement. Pediatrics 2005; 116:1026-1035; aappolicy.aappublications.org/cgi/content/full/pediatrics;116/4/1026

American College of Obstetricians and Gynecologists. Emergency contraception. ACOG Practice Bulletin: Clinic Management Guidelines [No. 69]. Washington, DC: Author, December 2005; members can access this document at www.acog.org

American Medical Association, Council on Medical Service. Access to Emergency Contraception [H-75.985] Chicago, IL: AMA, 2006; www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/H-75.985.HTM.

American Medical Women’s Association. Emergency Contraception. Arlington, VA: Author, 2005; http://www.amwa-doc.org/index.cfm?objectid=0EF88909-D567-0B25-531927EE4CC23EFB

American Pharmacists Association: Emergency Contraception: the Pharmacist’s Role, updated edition [APhA Special Report] Washington, DC: Author, 2004; this continuing education booklet is available online to members at www.aphanet.org/AM/Template.cfm?Section=Search&template=/CM/HTMLDisplay.cfm&ContentID=1913

Association of Reproductive Health Professionals. Position Statement; www.arhp.org/healthcareproviders/resources/ecresources/arhpposition.cfm

Society for Adolescent Medicine. Provision of emergency contraception to adolescents: position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 2004; 35:66-70; www.adolescenthealth.org/PositionPaper_Emergency_Contraception.pdf

Professional Resources on Emergency Contraceptive Pills

For current information about emergency contraception (EC), visit the following sites.

American Society for Emergency Contraception: www.emergencycontraception.org/asec/. ASEC is a collaboration of organizations working to improve women's access to emergency contraception (EC). ASEC is a:

  • Source of information on EC;
  • Watchdog for inaccurate or biased articles in the press;
  • Support to other organizations willing to endorse EC; and
  • Source of a semi-annual electronic newsletter on current EC news and events.

For the newsletter, visit www.emergencycontraception.org/asec/aseccontent-newsletters.html

Association of Reproductive Health Professionals: www.arhp.org/healthcareproviders/resources/ecresources/index.cfm. ARHP has a Web section devoted to EC, including professional and consumer health information, news, fact sheets, and training materials.

National Conference of State Legislatures 50 State Summary of Emergency Contraception Laws Denver CO: Author, 2006; www.ncsl.org/programs/health/ECleg.htm Updated annually, this offers a quick and accurate guide to each state’s laws, if any, on EC.

Not-2-Late.com: http://ec.princeton.edu  Operated by the Office of Population Research at Princeton University and by the Association of Reproductive Health Professionals, the site offers accurate information – for professionals and consumers – about emergency contraceptive pills, including:

  • Nationwide (but not comprehensive) directory of medical professionals who will prescribe EC and pharmacies that will fill prescriptions;
  • Current brands of oral contraceptives approved for use as EC; and
  • Summary of current research.

Recent Literature Reviews on Emergency Contraceptive Pills

In addition to the literature reviews included in the position statements of the American Academy of Pediatrics, the American Medical Women’s Association, and the Society for Adolescent Medicine (see links in the first section), other important literature reviews (circa 2004 or later) are listed here.

Conard LAE, Fortenberry JD, Blythe MJ, Orr DP. Emergency contraceptive pills: a review of the recent literature. Current Opinion in Obstetrics & Gynecology 2004; 16:389-395.

International Consortium for Emergency Contraception. Emergency Contraceptive Pills: Medical and Service Delivery Guidelines, 2nd ed. New York: Author, 2004; www.cecinfo.org/publications/PDFs/resources/MedicalServiceDelivery
Guidelines_Eng.pdf

Ranney ML, Gee EM, Merchant RC. Nonprescription availability of emergency contraception in the United States: current status, controversies, and impact on emergency medicine practice. Annals of Emergency Medicine 2006; 47:461-471

Trussell J, Stewart F, Raymond EG. Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy. Princeton, NJ: Office of Population Research, Princeton University, February 2008. Available online at http://ec.princeton.edu/questions/ec-review.pdf

Additional Information for Professionals and Consumers about EC

Food and Drug Administration (FDA):  On August 24, 2006, the FDA (www.fda.gov ) approved nonprescription sales for Plan B® for women 18 years and older. Visit: http://www.fda.gov/bbs/topics/NEWS/2006/NEW01436.html

Reproductive Health Technologies Project: www.rhtp.org  Provides information about reproductive health issues, including EC.

Physicians for Reproductive Choice and Health: PRCH offers Resources: Emergency Contraception: A Practitioner’s Guide at www.prch.org/content/index.php?pid=155

World Health OrganizationMedical Eligibility Criteria for Contraceptive Use, 3rd edition, 2004; www.who.int/reproductive-health/publications/mec/index.htm

Consumer Health Information Regarding EC

Emergency Contraception Web Site: http://ec.princeton.edu   The site provides accurate information and a directory of local clinicians willing to provide EC.

Advocates for Youth: www.advocatesforyouth.org This site offers reliable and accurate information about EC – for professionals, youth, and parents. It also offers access to Advocates’ unique library of research on adolescent reproductive and sexual health.

Back Up Your Birth Control: www.backupyourbirthcontrol.org The Campaign encourages women to get emergency contraceptive pills from their health care provider before they need them.

Go Ask Alice: www.goaskalice.columbia.edu Produced by Columbia University's Health Education Program, this site has questions and answers on all kinds of relationship, sexuality, and sexual health issues.

Planned Parenthood Federation of America: http://www.plannedparenthood.org/health-topics/emergency-contraception-morning-after-pill-4363.htm This page offers information on EC, its history, barriers to access, and the difference between emergency contraception and abortion as well as referral to local clinics.

Sex Etc: www.sexetc.org By teens and for teens, this site helps youth stay healthy, including avoiding unintended pregnancy.

Planned Parenthood Teens: http://www.plannedparenthood.org/teens This site offers reliable and accurate information on sexuality and relationships as well as referral to local Planned Parenthood clinics.

* For a comprehensive bibliography of medical and public health research related to emergency contraceptive pills, please visit: www.morningafterinfo.org


Compiled by Sue Alford, MLS for Advocates for Youth © 2009
An earlier version of this publication was funded by New Morning Foundation

This publication is a part of the From Research to Practice series. 

Read more...
 
Youth Reproductive and Sexual Health in Botswana Print

Also available in [PDF] format.

Young people ages 10 to 24 comprise 700,000, or 38.9 percent, of the 1.8 million people living in Botswana.1 This group of young people is the largest group ever to be entering adulthood in Botswana’s history. But largely because of the devastation caused by HIV and AIDS, Botswana's population is currently declining -  it is projected that in 2025, there will be six-hundred thousand young people ages 10 to 24 in the country.1 Young people in Botswana, especially young women, face many challenges to their sexual and reproductive health, including high rates of maternal mortality, increased risk of violence and HIV due to widespread alcohol abuse, and the second highest HIV prevalence of any nation. Youth-inclusive, science-based programs can provide young people with sexual health information, life skills, and services to meet their sexual and reproductive health needs.

Some Health Indicators are Encouraging, but Young People Remain at Risk for Negative Sexual Health Outcomes

  • Among unmarried adolescents, the average age of sexual initiation is 17.5 years.2 
  • In one study, among young people ages 15-24, 88 percent of men and 75 percent of women used a condom at their last high-risk sexual activity (sex with a non-regular partner).3  
  • While information on contraceptive use among young people in general is not available, less than half of married women (44 percent) ages 15-49, use contraception.1 
  • Over a quarter of young women ages 15-19 have begun having children.4   Among 12-14 year old females in 2001, 12 percent had been pregnant, and 47.3 percent of 15-24 year olds had been pregnant.5  
  • In Botswana, the maternal death rate is high at 326 per 100,000 live births.   Risk is higher among teenaged mothers because they are more likely to experience an unsafe abortion and because they experience a higher risk of complications at birth due to underdeveloped bodies.5
  • Among young people ages 15-24, the prevalence of HIV/AIDS is on the decline, but still very high with 15.3 percent of young women and 5.1 percent of young men living with HIV in 2007 as opposed to 30-45 percent and 12.9-19.3 percent living with HIV, respectively, in 2001.7,16 
  • There is no formal sex education in schools in Botswana, and studies show that many parents are uncomfortable talking about sexuality with their children.  However, young people receive some information about sexuality and HIV prevention both informally from friends and acquaintances, and through Botswana's HIV prevention social marketing programs.2

Young People, Especially Young Women, are at Serious Risk of HIV Infection

  • The national HIV prevalence of adults between the ages of 15-49 is 24.9 percent, ranked second highest in the world.7
  • AIDS is the leading cause of death in Botswana and has drastically affected its citizens. Within 15 years, from 1990-2005, life expectancy in Botswana dropped drastically from 65 years to 34 years.1 
  • One study indicates that among youth ages 15-24, as many as 76 percent of young men and 81 percent of young women knew that a healthy-looking person could be infected with HIV.8 But only 33 percent of young men and 40 percent of young women could both identify 2 methods of preventing the transmission of HIV, and reject 3 misconceptions about HIV transmission - indicating that a significant number of young people do not have complete information about HIV.3
  • UNAIDS reports that HIV prevalence among young women ages 15-24 (15.3 percent) is triple that among young men (5.1 percent)..7
  • A total of 57 percent of HIV-infected adults in Botswana are women.3
  • This disproportionate increased risk for HIV transcends the existence of positive trends in education and literacy. For example, women in Botswana have higher literacy rates and higher secondary school enrollment rates than their male counterparts.9 There are, however, still economic disparities between men and women. Forty six percent of females compared to 65 percent of males were found to be economically active.1

Alcohol Abuse Contributes to HIV Risk and Violence

  • In Botswana, alcohol abuse remains the most common form of primary substance abuse, and is strongly associated with HIV risk.10   
  • In a study of adults ages 15-49, from 5 districts in Botswana, 31 percent of men and 17 percent of women met the criteria for heavy alcohol consumption. Heavy alcohol use was associated among men with higher HIV risk behaviors, including  being three to four times as likely to have unprotected sex or multiple partners or to pay for sex. Among women heavy alcohol use was associated with higher rates of unprotected sex and multiple partners, and heavy alcohol users were eight times as likely to sell sex as nondrinkers.10
  • Alcohol abuse combined with existing gender imbalances lead to marital rape and abusive relationships, putting women at risk not just of physical, sexual, and emotional distress but at increased risk of contracting HIV (since condoms are rarely used during sexual assaults).11 

Programs Seek to Help Young People Lead Healthy Lives

  • The Basha Lesdi ("Youth are the Light") project, funded by the US Centers for Disease Control and Prevention (CDC), focuses on youth ages 10 to 17 in Botswana. The project hopes to reach young people with HIV/AIDS prevention information and skills before they engage in risky behaviors, while also developing support from community stakeholders including faith-based groups.12
  • The Social Marketing or Adolescent Health (SMASH) Project, funded by USAID, engaged young people on sexual health issues by facilitating dialogues on reproductive and sexual health through a radio call-in show, youth clubs in schools, peer education, and youth-friendly clinics. The project reports a positive impact resulting from young people’s participation in its design and implementation.13  
  • The African Youth Alliance (AYA) worked in Botswana with youth to plan programs to improve adolescent knowledge, attitudes, values and behavior on matters related to sexual and reproductive health issues, including STIs, HIV/AIDS, smoking, alcohol and substance abuse, as well as to increase the use of sexual and reproductive health information and services.14 
  • Advocates for Youth's YouthLIFE Initiative (Youth Leaders Fighting the Epidemic), was implemented in Botswana, South Africa and Nigeria with a focus on building the capacity of youth-led organizations to better implement HIV prevention programs for youth. In Botswana, Advocates worked with the Youth Health Organization (YOHO) to implement youth-specific HIV/AIDS “edutainment” interventions and to secure greater participation by youth in policy-making bodies.15   

Written by Mimi (Meheret) Melles
Advocates for Youth © April 2009

References:

  1. Population Reference Bureau. “Botswana.” Accessed from http://www.prb.org/Countries/Botswana.aspx on March 27, 2009.
  2. Francoeur, RT and Noonan, RJ. “Botswana.”  International Encyclopedia of Sexuality. Kinsey Institute, 2004. Accessed from http://www.kinseyinstitute.org/ccies/bw.php on March 27, 2009.
  3. UNAIDS. “Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Diseases: Botswana.” United Nations, 2006.
  4. United Nations Population Fund.  “Overview:  Botswana.” UNFPA, 2005.  Accessed from http://www.unfpa.org/profile/botswana.cfm on March 14, 2008.
  5. United Nations and the Republic of Botswana.  “Goal 5: Maternal Health.” Botswana: Millennium Development Goals Status Report. UNFPA, 2004. Accessed from http://www.unbotswana.org.bw/undp/docs/mdg_status_report_2004.pdf on March 27, 2009.
  6. Author. Maternal mortality in 2005 : estimates developed by WHO, UNICEF, UNFPA, and the World Bank. World Health Organization, 2007. Accessed from http://www.who.int/whosis/mme_2005.pdf on March 27, 2009.
  7. Joint United Nations Programme on HIV AIDS (UNAIDS). 2008 Report on the Global AIDS Epidemic, Geneva, Switzerland: UNAIDS, 2008. Accessed from http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport
    /2008/2008_Global_report.asp
    on March 27, 2009.
  8. UNAIDS. “The HIV/AIDS Epidemic in Botswana.” 2004 Report on the Global AIDS Epidemic. UNAIDS, 2004.
  9. Author. “Botswana.” UNICEF, 2008. Accessed from http://www.unicef.org/infobycountry/botswana_statistics.html on March 27, 2009.
  10. Weiser SD et al.  “A population-based study on alcohol and high-risk sexual behaviors in Botswana.” PLOS Medicine, 2006; 3 (10): e392. 
  11. Phorano O et al. “Alcohol abuse, gender-based violence and HIV/AIDS in Botswana: establishing the link based on empirical evidence.” Sahara J, 2005 Apr;2(1):188-202.
  12. Author. “Global Programs: Basha, Lesedi (Botswana).” FHI Focus on Youth. Family Health International. Accessed from http://www.fhi.org/en/Youth/index.htm on March 27, 2009.
  13. Author. Social Marketing for Adolescent Health. Population Reference Bureau, 2000.  Accessed from http://www.phishare.org/files/228_SMASH.pdf on March 27, 2009.
  14. Author.  “United Nations in Botswana.” UNFPA.  Accessed from http://www.unbotswana.org.bw/aya.html on March 27, 2009.
  15. Devries, KO. “YouthLIFE – Botswana, Nigeria, and South Africa.” Advocates for Youth, 2003.  Accessed from http://www.advocatesforyouth.org/about/youthlife.htm on March 27, 2009.
  16. Author. Young People and HIV/AIDS: Opportunity in Crisis.  United Nations Children’s Fund, Joint United Nations Programme on HIV/AIDS, and World Health Organization, 2002.  Accessed from http://www.unicef.org/newsline/HIV_10REV67.pdf on May 4, 2009.
This publication is a part of the The Facts series.
 
Science & Success: Programs that Work to Prevent Subsequent Pregnancy among Adolescent Mothers Print

Also available in [PDF] format. Order publication online.

Table of Contents

Introduction

Program Descriptions and Evaluation Results

  1. Queens Hospital Center’s Comprehensive Adolescent Program for Teenage Mothers and Their Children
  2. Health Care Program for First-Time Adolescent Mothers
  3. Nurse Home Visiting for First-Time Adolescent Mothers
  4. Polly T. McCabe Center for Pregnant Adolescents
  5. Women’s Centre of Jamaica Foundation Programme for Adolescent Mothers
  6. Home-Based Mentoring for First-Time Adolescent Mothers
  7. Intensive School-Based Program for Teen Mothers

References

© 2009, Advocates for Youth
Written by Sue Alford, MLS, with significant assistance from Anne Rutledge and Barbara Huberman.

This publication is part of Science and Success, Programs that Work series. 

 
Best Practices for Family Planning Clinics Print

This needs and assets assessment tool offers clinic administrators and staff an overview of “best practices” for family planning service delivery. Categorized into sections, the tool gives you an opportunity to learn about the latest research and best practices and then, using this information, rate how your clinic fares.  

The tool draws on research from four key sources:

  • Alford S. From Research to Practice: Youth-Friendly Reproductive and Sexual Health Services. Washington, DC: Advocates for Youth, 2009.
  • Alford S. Science and Success.  Washington, DC: Advocates for Youth, 2008.
  • Burlew R, Philliber S. What Helps in Providing Contraceptive Services for Teens. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2006.
  • Kirby D. Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Washington, DC: National Campaign, 2007.
It allows you to assess whether best practices are in place in your clinic with respect to: 
  • Confidentiality
  • Respectful treatment
  • Screening and counseling
  • Integrated services
  • Cultural competency
  • Accessible and affordable care
  • Reproductive and sexual health care
  • Staff development
  • Services for young men
  • Parent-child communication
Please indicate the degree to which you feel the organization practices each standard by circling the appropriate rating (1) to (5) where 1= never, 2= rarely, 3= sometimes, 4= often, and 5= always. Total your scores for each section to create an overall “category score.”

 

 I.  Confidentiality

Best Practice: Assure that Young People Have Confidential Access to Contraceptive Services.
   Never   
 Rarely   
 Sometimes   
 Often   
 Always
1. Staff has a clear understanding of the state’s laws in relation to informed consent, client confidentiality, and parental notification.  1  2  3  4  5
2. Every clinic staff member, including receptionists, medical assistants, and technicians, is trained about the importance of guarding adolescents’ confidentiality.
 1  2  3  4  5
3. We emphasize the protections rather than limits of confidentiality when interacting with teens.  1  2  3  4  5
 4. We make sure always to have some counseling time alone with adolescent patients, even when they are accompanied to the appointment by a parent or a partner. Staff treats unaccompanied minors as well.
 1  2  3  4  5
5. We refer minors to a pharmacy where their confidentiality will be respected    
 1  2  3  4  5
6. We give extra assurances of confidentiality to HIV-positive youth, undocumented youth, older adolescents, GLBTQ youth, and pregnant and parenting teens.    
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  

 

 II.  Respectful Treatment

Best Practice: Treat Teens with Dignity and Respect.

   Never   
 Rarely   
 Sometimes   
 Often   
 Always
1. Every staff member – from clinicians to receptionists – receives training in adolescent development and in treating youth respectfully. Staff is comfortable working with youth.
 1  2  3  4  5
2. Staff schedules longer visits with adolescent clients than with adults.
 1  2  3  4  5
3. All clinicians and counselors are trained in how to raise sensitive issues, including sexual health, condom and contraceptive use, substance use, interpersonal violence, and mental health.  1  2  3  4  5
4. Clinic staff treat every youth as a whole person and involves teens in their own health management.
 1  2  3  4  5
5. A clinic staff member always asks teen clients if they want a chaperone present during an examination.
 1  2  3  4  5
6. Clinicians explain the reasons for a particular test as well as what is involved in the test.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  

 

III.  Integrated Care

Best Practice: Use an Integrated, Multidisciplinary, Holistic Approach to Health Care.

   Never   
 Rarely   
 Sometimes   
 Often   
 Always
1. We establish protocols to ensure that youth receive preventive counseling as recommended by GAPS (American Medical Association) or other major medical organizations.  1  2  3  4  5
2. We have protocols that ensure that clinicians screen and counsel every adolescent. We follow the recommendations of the American Medical Association, Society for Adolescent Medicine, and/or American Academy of Pediatrics.
 1  2  3  4  5
3. We screen every teen for depression, interpersonal violence, and a history of abuse because we know that these factors can have a profound effect on adolescents’ risk-taking and health-seeking behaviors.
 1  2  3  4  5
4. We screen every teen for current risk-taking behaviors, including substance use, unprotected sex, exposure to or participation in violent behaviors, poor nutrition, inadequate exercise, and social problems.
 1  2  3  4  5
5. We recognize that some teens, including teen parents and those in foster care, homeless shelters, juvenile detention centers, and substance abuse programs, have higher rates of risk-taking than other teens. Therefore, we set up strong referral systems, co-locate services, and/or establish collaborative partnerships with agencies who serve these youth.
 1  2  3  4  5
6. We develop links with school-based health clinics, which we know are especially effective in serving teens but are often unable to provide contraceptive and family planning services.
 1  2  3  4  5
7. Recognizing that many youth use the hospital emergency department as their usual source of care and, thus, may not receive comprehensive care, we connect with local ER’s so they can refer youth to us for family planning and other care.
 1  2  3  4  5
8. To the extent possible, we try to ensure continuity of care by making every effort to have teens see the same counselor and/or clinicians at every appointment.
 1  2  3  4  5
9. The breadth of the clinic’s services is widely advertised. Clinic staff actively use “in-reach” as well as outreach by asking adolescent clients to recommend services to their friends.
 1  2  3  4  5
10. We make referral appointments for adolescents and ensure that they know exactly where and when to go, giving them clear directions, assurances of continuing confidentiality and information about fees, if any.
 1  2  3  4  5
11. We provide a sheet of paper with the adolescent’s correctly spelled diagnosis and medications, if any, along with reliable, accurate consumer health information Web sites.
 1  2  3  4  5
12. We are aware that integrated care is especially important to some populations of youth, especially young men, pregnant teens, GLBTQ youth, HIV-positive adolescents, and sexual assault survivors.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  

 

 IV.  Cultural Competency

Best Practice: Offer Culturally Competent Services and Tailor Services to Meet the Needs of Teen Clients.

   Never   
 Rarely   
 Sometimes   
 Often   
 Always
1. We have ongoing training for all staff regarding cultural norms, adolescent development, sexual orientation and gender identity, and cultural competency.
 1  2  3  4  5
2. We have clear, unambiguous policies against discrimination on the basis of sex, age, race/ethnicity, sexual orientation, religion, and gender identity. We ensure that the clinic or practice is a safe place for all clients and staff.
 1  2  3  4  5
3. We hire staff who represent our client population and who are diverse in many ways, including gender and ethnicity. We pay attention to gender role dynamics between staff and clients.
 1  2  3  4  5
4. We ensure that staff can communicate with clients in their own language(s). We ensure that bi-lingual staff is available, either during all operating hours or at set times and on set days.
 1  2  3  4  5
5. We ensure that age-appropriate, high quality consumer health materials and consent forms are available in all the languages that clients speak and for various reading levels, including low literacy.
 1  2  3  4  5

6. We involve young people in assessing the policies and services offered by the clinic and we take their recommendations seriously.
 1  2  3  4  5
7. Our waiting rooms and examining rooms have a gender neutral décor, reassuring both young men and young women that they belong there and are welcome.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  

 

 V.  Accessible and Affordable Services

Best Practice: Ensure that Services are Affordable and Accessible for Teens.

   Never   
 Rarely   
 Sometimes   
 Often   
 Always
1. We offer transportation vouchers to youth and/or we link with community clinics in the area so that youth can use a clinic closer to their home,  school, or work.  1  2  3  4  5

2. We offer a special help-line that adolescents can use to inquire about services, to make appointments, and to request follow-up care.
 1  2  3  4  5
3. We offer flexible hours for adolescents including appointments in the evening and on weekends. We accept walk-in appointments.  1  2  3  4  5
4. We get a cell number and/or private e-mail address for youth. We contact youth within 24 hours with their test results and keep a confidential log book to document follow-up, treatment, and partner notifications
 1  2  3  4  5
5. We offer free or greatly reduced fees for services to teens.
 1  2  3  4  5
6. We dispense free or low cost prescriptions to teens.
 1  2  3  4  5
7. Where possible, we offer private billing accounts for teens to ensure confidentiality.
 1  2  3  4  5
8. We stock exam rooms (and /or the waiting room) with baskets of free condoms along with signs saying that youth are free to take as many as they feel they need.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  

 

 VI.  Reproductive & Sexual Health Services

Best Practice: Establish Teen-Specific Protocols for Reproductive & Sexual Health Services.

   Never   
 Rarely   
 Sometimes   
 Often   
 Always
1. We use a teen-friendly standardized form for eliciting sexual history.
 1  2  3  4  5
2. We offer adolescent women a complete array of hormonal contraceptive methods. When an adolescent chooses the pill, patch, or ring, we encourage her to begin her method immediately and to use condoms for additional protection against pregnancy for the first seven days after she has begun.
 1  2  3  4  5
3. We explain the difference between the relative risks and the absolute risks associated with contraceptive options.
 1  2  3  4  5
4. We stress the importance of using dual protection – that is, of using hormonal contraception or other barrier method to prevent pregnancy and condoms to reduce the risk of HIV and STIs to all female clients, regardless of their sexual orientation. We counsel all sexually active youth to use condoms or dental dams at every act of sex to prevent or lessen the risk of infection with STIs, including HIV.
 1  2  3  4  5
5. We don’t require a pelvic exam before prescribing or dispensing hormonal contraception to adolescents. We do the first Pap test three years after the first experience of vaginal intercourse or at 21 years of age, whichever comes first.
 1  2  3  4  5
6. We don’t require a pregnancy test before offering emergency contraception. 
 1  2  3  4  5
7. For purposes of partner notification, we ask about sexual partners for the previous two weeks to one month for herpes and most bacterial infections, in the past two months for chlamydia and gonorrhea infections, and in the past year for HIV infection. We do not limit screening to symptomatic clients.
 1  2  3  4  5
8. We screen consistently for Chlamydia and Gonorrhea, using urine-based testing.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  

 

 VII.  Services for Young Men

Best Practice: Recognize that young men have sexual and reproductive health needs of their own.

   Never   
 Rarely   
 Sometimes   
 Often   
 Always
1. We offer holistic care to all young men, regardless of their sexual orientation, that addresses their physical, emotional, and social health.
 1  2  3  4  5
2. We link with other community health clinics and agencies so that other agencies can refer young men to us and we can easily and readily refer young men to nearby care in venues where they will feel that no one will know why they are there.
 1  2  3  4  5
3. We train all clinic staff about the importance of guarding male adolescents’ confidentiality, especially with regard to their peers  1  2  3  4  5
4. We advertise the breadth of the clinic’s services, especially in venues where young men congregate. To make our services known, we use ‘in-reach’ as well as outreach, asking our clients to recommend our services to young men they know.
 1  2  3  4  5
5. We screen all young men under age 25 for Chlamydia and gonorrhea, except when the prevalence in our client population is less than two percent. We consider separately the populations of young men who do and do not have sex with other men. We do not limit screening to symptomatic males.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  

 

 VIII.  Parent-Child Communication

Best Practice:  Help parents support their teen’s reproductive and sexual health needs. 

   Never   
 Rarely   
 Sometimes   
 Often   
 Always
1. We advertise and offer workshops for parents on how to talk with their teens and younger children about sensitive sexual health issues.
 1  2  3  4  5
2. We work with other agencies in our community to promote parenting skills and to prevent teen pregnancy, adolescent substance use, and other adolescent risk behaviors.
 1  2  3  4  5
3. We offer pamphlets, Web information, and other materials, in a variety of languages and reading levels to help parents talk with adolescents about sexuality and other sensitive health issues.  1  2  3  4  5
4. We help parents understand the importance of confidential care for adolescents.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  


 
Êtes-vous un parent abordable? Print

Aussi disponible en anglais [HTML].

Comme vous êtes un parent ou gardien, il est important que vous soyez abordable. Que signifie ce mot? Comment est-ce que les adultes deviennent abordables? D’être abordable signifie que les jeunes vous trouvent d’un abord facile et ouvert aux questions. D’être abordable à propos de la sexualité est très difficile pour certains parents ou gardiens. C’est possible que les adultes n’aient pas reçu aucune ou peu d’information à propos des rapports sexuels quand ils étaient jeunes. Peut-être les rapports sexuels n’étaient pas discutés à la maison, à cause de craintes ou embarras. En outre les adultes pourraient s’inquiéter parce qu’ils :

  • Ne connaissent pas les bons termes ou les bonnes réponses ;
  • Ne sont pas “au courant” selon les jeunes ;
  • Donnent trop ou pas assez d’information ; ou
  • Donnent l’information au mauvais moment.  

Il est important d’être abordable. La recherche montre que les jeunes ayant reçu le moins d’information sur la sexualité et sur les comportements sexuels de haute risque pourraient expérimenter plus et à un âge plus jeune que les jeunes qui ont reçu plus d’information.1,2,3,4,5  

La recherche montre aussi que quand les adolescents ont l’opportunité de parler avec un parent ou un autre adulte à propos des rapports sexuels et la protection, il est moins probable qu’ils vont avoir les rapports sexuels à un âge très jeune et/ou non protégés que les adolescents qui n’avaient pas parlé avec un adulte fidèle.6,7,8,9  Finalement, les jeunes disent souvent qu’ils veulent discuter des rapports sexuels et la santé sexuelle avec leurs parents—les parents sont leurs ressources préférées de l’information sur ces sujets.10,11

Parce qu’il est très important d’être abordable et parce qu’il y a beaucoup d’adultes qui ont du mal à initier les discussions à propos des rapports sexuels avec leurs enfants, les adultes pourraient avoir besoin d’apprendre les nouvelles compétences et devenir plus confiants de leur capacité d'en discuter. Voici quelques conseils des experts de l’éducation sexuelle.  

Parler avec les Jeunes à Propos de la Sexualité  

  1. Obtenir une bonne fondation générale de l’information factuelle des ressources fiables. Souvenez-vous que la sexualité est un sujet beaucoup plus vaste que les rapports sexuels. Elle comprend aussi la biologie et le sexe mais aussi les émotions, l’intimité, l’affection, le partage, l’amour, les comportements, le flirt et l’orientation sexuelle ainsi que la reproduction et les rapports sexuels.
  2. Apprendre et utiliser les termes corrects pour les parties du corps et les fonctions. Si vous avez de difficulté à dire certains termes sans embarras, pratiquer à dire ces termes en privé avant un miroir jusqu’au moment que vous êtes à l’aise avec eux et que vous les trouvez non sexuels. Par exemple, vous devriez être capable à dire « pénis » aussi facilement que « coude ».
  3. Réfléchissez sur vos émotions et valeurs à propos de l’amour et les rapports sexuels. Revenez à vos souvenirs de jeunesse, votre première amourette, vos valeurs, et comment vous vous sentez sur les sujets liés aux rapports sexuels, comme les méthodes de contraception, les droits de la reproduction, l’égalité sexuelle, le sexe, et l’orientation sexuelle. Vous devriez être conscient de comment vous vous sentez avant de parler effectivement avec les jeunes.
  4. Parlez avec votre enfant. Écoutez plus que vous parlez. Assurez que vous et votre enfant avez une communication ouverte et bilatérale parce qu’elle est la base d’une relation positive entre vous et votre enfant. Seulement en écoutant l’un l’autre, surtout à propos de l’amour et la sexualité, va vous et votre enfant vous comprendre.
  5. Ne pas vous vous inquiéter de — 
    • Être « au courant ». Les jeunes sont comme ça avec leurs paires déjà. Ils veulent savoir ce que vous croyez, qui vous êtes et comment vous vous sentez.
    • Être embarrassé. Vos enfants sont aussi embarrassés. Ce n’est pas grave car l’amour et plusieurs aspects de la sexualité, les rapports sexuels inclus, sont très personnels. Vos enfants comprennent ce fait aussi.
    • Décider quel parent doit parler. Tous les parents et les gardiens affectueux peuvent être un éducateur effectif pour ses enfants.
    • Ne pas avoir une réponse à une question. Vous pouvez dire que vous ne savez pas. Vous pouvez lui dire que vous allez trouver la réponse ou vous pouvez la trouver ensemble. Et puis le faire. 

Parler avec les Jeunes Enfants  

  1. Souvenez-vous que si quelqu’un est assez âgé pour demander, il/elle est assez âgé(e) pour savoir la réponse correcte et à apprendre les termes corrects.
  2. Êtes certain que vous compreniez ce que l’enfant vous demande. Vérifiez. Par exemple, vous pouvez demander, « Je ne suis pas sûr que j’ai bien compris ce que tu m’as demandé. Est-ce que tu me demandes si c’est ok que les gens font XX ou pourquoi les gens font XX? » Vous ne voulez pas donner une longue explication qui ne répond pas à ce que l’enfant a demandé.
  3. Répondez à la question quand elle est demandée. Normalement, il est mieux de risquer l’embarras de quelques adultes (au supermarché, par exemple) que d’embarrasser votre enfant ou de gâcher une opportunité de faire comprendre à votre enfant. Votre enfant préfère que vous lui répondiez au même moment. Si vous ne pouvez pas répondre au moment donné, assurez-vous que l’enfant est content qu’il ait demandé la question et donnez lui un temps quand vous pourriez répondre. « Je suis content que tu m’a demandé. Nous allons en parler quand nous rentrons à la maison. »  
  4. Répondez juste au-dessus du niveau que vous pensez que votre enfant comprendrait, parce que vous pourriez le sous-estimer et ce va créer une porte d’entrer pour les questions à venir. Par exemple, quand vous êtes demandé à expliquer les différences entre les garçons et filles, ne sortez pas un manuel et montrez les dessins des organes sexuels à votre enfant. Un jeune enfant souhaite savoir ce qui est à l’extérieur. Donc vous pouvez dire simplement qu’un garçon a un pénis et une fille a une vulve.  
  5. Souvenez-vous que, même avec les enfants, vous devez établir les limites. Vous pouvez refuser de répondre à une question très personnelle. « Ce qui se passe entre votre père et moi est personnel et je ne veux pas le discuter avec les autres. » Aussi, assurez que votre enfant comprend la différence entre les valeurs et normes liées à sa question. Par exemple, si l’enfant demande s’il ne faut pas masturber, vous pouvez dire, « la masturbation n’est pas mauvaise ; par contre, nous ne la fait pas en public. Elle est faite en privé. » [valeurs versus normes] Vous devez aussi cautionner votre enfant que les autres adultes ont des valeurs différentes sur ce sujet même s’ils ont les mêmes normes ; ça va dire qu’ils pensent que cet un comportement mauvais mais c’est fait en privé.  

Parler avec les Adolescents  

  1. Rappelez-vous de comment vous vous sentiez quand vous étiez un adolescent. Souvenez-vous que l’adolescence est une période difficile. D’un moment, l’ado souhaite avoir une identité séparée et l’indépendance et à un autre moment, il a besoin de soutien de ses parents.
  2. Souvenez-vous que les ados veulent avoir les conversations mutellement respectueuses. Éviter d’imposer. Partagez vos sentiments, valeurs, attitudes et écoutez et apprenez les siens. Souvenez-vous que vous ne pouvez pas imposer les sentiments, valeurs et attitudes sur quelqu’un d’autre.
  3. Ne présumez pas qu’un ado a de l’expérience ou pas, est savant ou naïf. Écoutez attentivement à ce que l’ado dit et/ou demande. Répondez à la question de l’ado, pas à vos préoccupations ou craintes.
  4. Ne pas sous-estimer la capacité de votre ado à évaluer les avantages est désavantages des options variées. Les adolescents ont les valeurs et ils sont capables de prendre les décisions saines, surtout quand ils ont tous les faits et l’opportunité de les discuter avec un adulte de grand secours. Si vous donnez à votre adolescent de la mauvaise information, il va perdre de confiance en vous, mais si vous le donner de la bonne information qui est claire et correcte, il va avoir plus de confiance.  Bien sûr que les décisions d’un adolescent ne seraient pas toujours les mêmes que vous prendriez mais c’est une question d’âge. D’être un parent abordable est un élément des rapports qui dure de toute une vie. Il ouvre les portes pour les rapports plus proches et les liens familials. Il n’est jamais trop tard pour commencer !  

French translation courtesy of Institute for Reproductive Health, Georgetown University.

 

References

  1. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001.
  2. Baldo M, Aggleton P, Slutkin G. Does Sex Education Lead to Earlier or Increased Sexual Activity in Youth? Presentation at the IX International Conference on AIDS, Berlin, 6-10 June, 1993. Geneva: World Health Organization, 1993.
  3. UNAIDS. Impact of HIV and Sexual Health Education on the Sexual Behaviour of Young People: A Review Update. [UNAIDS Best Practice Collection, Key Material] Geneva: UNAIDS, 1997.
  4. Alford S et al. Science & Success:Sex Education & Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003.
  5. Thomas MH. Abstinence-based programs for prevention of adolescent pregnancies: a review. Journal of Adolescent Health 2000; 26:5-17.
  6. Miller KS et al. Patterns of condom use among adolescents: the impact of mother-adolescent communication. American Journal of Public Health 1998; 88:1542-1544.
  7. Shoop DM, Davidson PM. AIDS and adolescents: the relation of parent and partner communication to adolescent condom use. Journal of Adolescence 1994; 17:137-148.
  8. Jemmott LS, Jemmott JB. Family structure, parental strictness, and sexual behavior among inner-city black male adolescents. Journal of Adolescent Research 1992; 7:192-207.
  9. Rodgers KB. Parenting processes related to sexual risk-taking behaviors of adolescent males and females. Journal of Marriage and Family 1999; 61:99-109.
  10. Hacker KA et al. Listening to youth: teen perspectives on pregnancy prevention. Journal of Adolescent Health 2000; 26:279-288.
  11. Kaiser Family Foundation, Nickelodeon, and Children Now. Talking with Kids about Tough Issues: a National Survey of Parents and Kids. Menlo Park, California: The Foundation, 2001.

Written by Barbara Huberman, RN, MEd, and by Sue Alford, MLS
© 2005, Advocates for Youth

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